自体骨髓干细胞移植治疗2型糖尿病的安全性及有效性

Efficacy and safety of autologous bone marrow stem cells transplantation for type 2 diabetes mellitus

目的探讨自体骨髓干细胞(bone marrow stem cells,BMSCs)经胰背动脉移植治疗2型糖尿病(type 2 diabe-tes mellitus,T2DM)的有效性及安全性。方法回顾性分析2009年6月至2011年4月在我科住院符合纳入标准的6例2型糖尿病患者(3男3女),年龄(45.67±14.92)岁,实施自体骨髓干细胞移植。①动员骨髓;②采集骨髓;③分离骨髓干细胞;④将骨髓干细胞注入胰背动脉;⑤观察移植前后血糖、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、胰岛功能、C肽曲线下面积(area under curve for C-peptide,AUCC)及胰岛素用量等变化,记录治疗过程中及治疗后的不良反应;对干细胞移植的安全性及疗效进行评估。结果移植前后:①糖化血红蛋白由(10.33±2.78)%降至(7.05±0.90)%,有2例患者的糖化血红蛋白<7%;②空腹C肽(fasting C-peptide,FC-P)由(0.71±0.54)ng/ml升至(1.54±0.63)ng/ml(P<0.05),餐后2 h C肽(2 h postprandial C-peptide,2 h C-P)由(1.63±0.88)ng/ml升至(4.67±2.31)ng/ml(P<0.05),C肽曲线下面积由(2.29±1.31)ng/ml增至(6.05±2.94)ng/ml(P<0.05);③胰岛素用量由(27.17±13.08)U/d降到(18.63±7.04)U/d,其中2位患者停用皮下注射胰岛素改为口服药物降糖治疗;④自体骨髓干细胞移植过程中及术后随访均未观察到不良反应,移植前后肿瘤标志物及血淀粉酶均正常。结论自体骨髓来源干细胞移植可改善2型糖尿病患者的胰岛功能,减轻其对外源性降糖药物的依赖,且安全性可行。

Objective To study （BMSCs） transplantation via dorsal pancreatic the efficacy and safety of autologous bone marrow stem cells artery （DPA） for type 2 diabetes mellitus （T2DM）. Methods Six T2DM patients aged 45.67 _＋ 14.92 years （3 males and 3 females） admitted to our department from June 2009 to April 2011 were enrolled in this study. The patients underwent BMSCs transplantation. Their bone marrow was mobilized and collected. BMSCs were isolated and infused into the DPA. Changes in fasting and postprandial blood glucose level, glycosylated hemoglobin （ HbA1 c） value, function of pancreatic islets, area under curve for C-peptide （AUCC）, and insulin dose were observed. Adverse reactions of BM-SC transplanta- tion for T2DM were recorded during and after operation with its safety and efficacy assessed. Results The 1LIbA1 c value decreased from （ 10.33 ± 2.78 ） % before operation to （7.05 ± 0.90 ） % after operation, which was 〈7% in 2 patients. The fasting C-peptide （FC-P）level increased from （0.71 ±0.54 ） ng/ml before operation to （ 1.54 ± 0.63 ） ng/ml after operation. The 2 h postprandial C-peptide （ 2 h C-P） level increased from （1.63 ＋ 0. 88） ng/ml before operation to （4.67 ± 2.31 ） ng/ml after operation. The mean AUCC increased from （2.29 ± 1.31 ） ng/ml before operation to （ 6.05 ± 2.94 ） ng/ml after operation. The insulin dose decreased from （27.17 ± 13.08） U/d before operation to （18.63 ＋7.04） U/d after operation. Subcuta- neous insulin injection was withdrawn in 2 patients who changed to have oral hypoglycemic drugs. No adverse reaction occurred during autologous BMSCs transplantation and follow-up. The tumor markers and amylase level were normal before and after BMSCs transplantation. Conclusion Autologous BMSCs transplantation can improve the function of pancreatic islets of T2DM patients and decrease their dependence on hypoglycemic drugs with rather good safety.